COMMENTARY

Is Healthcare a Right or a Privilege?

John L. Marshall, MD

Disclosures

February 03, 2011

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Just as we predicted, Congress gets back in session in 2011 and the House immediately votes to repeal the healthcare reform bill. Of course, we all know that this is a bit of a show because we've got 2 other bodies of government that do not look like they're going to repeal it, but it at least gives us a chance to have a discussion about this. As we know, healthcare reform comes down to this: Is healthcare a right or a privilege? Most countries around the world that have healthcare have decided that healthcare is a right and that everyone should have it, no matter what.

In the United States, we've not been about that. Our system of healthcare has been one of a privilege. Back when I went to the pediatrician with my mom, we didn't have any coinsurance or forms. My mother wrote the pediatrician a check, and I could go to a fancier pediatrician or I could go more often to the pediatrician if I had the money to do that. Health insurance was devised to support those catastrophic things: hospitalizations, car wrecks, that sort of thing. It wasn't meant to cover the day-to-day maintenance of healthcare. Of course, this evolved over time.

Our medications became more expensive. You know the whole story. Health insurance broadened, so instead of being something for that panic moment, when some terrible thing happens, it became maintenance for us. It became our day-to-day livelihood. If you had a job, you got health insurance with it. It started to become a right of the employed. However, we didn't take care of those who didn't have health insurance, except that we did. If you don't have health insurance in the United States today, what happens? You show up at my emergency department and we'll take care of you. Who pays for that? We all do in the cost of our healthcare on the other side. We have 40 million people who are uninsured in the United States. That equals the entire country of Canada, the number of uninsured in the United States. What the healthcare debate is about is how to take care of those people.

We are a nation about self. We are not about others all that much. We are debating between freedom and government oversight. It's really what it comes down to. Okay? You have the freedom to not have health insurance. Fine. However, then it's my job, those who have health insurance, to rescue you when you fail. It gives you the freedom to fail, but if you then do fail, we catch you on the other side. If health insurance is a privilege and we don't force people to buy it, then how are we going to catch them? Are we just going to say, "Forget it, you were stupid. You didn't buy health insurance; therefore, you can't come into my hospital"? Or are we still going to catch them in some way?

This is the balance that we are struggling with in our country. I actually thought, now that I really drilled down on it, that the forcing of purchasing of insurance was a balance between freedom and government oversight. You had the choice of what kind of healthcare to buy, and you had to buy it in order to consume the product, but you weren't forced to have some government healthcare insurance. It was a balance between the two. What are we going to do with those people who are out in the cold? Are we just going to leave them out in the cold and not provide them healthcare because that was their choice, therefore making healthcare a privilege, or are we going to make it a right so that everybody gets access to it? If that's the case, how are we going to cover that?

If we leave people out in the cold, are we going to rescue them or not? Are we going to say, "you can come into our emergency rooms," or aren't we? That's the balance between freedom and government oversight, a fundamental discussion that we're having here in Washington, DC, on healthcare reform. You need to make up your own mind where you stand on this.

Thanks. John Marshall for Medscape.

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